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General NPI Number Information
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NPI Number | 1518692250
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Entity Type | Organization
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Legal Business Name | PREMIER SURGICAL ASSISTING LLC
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 4602 E SENECA ST
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City | TUCSON
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State | AZ
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Zip | 85712-3272
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Country | US
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Telephone | 208-241-0558
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Fax |
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Provider Business Mailing Address
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Address Line | 4602 E SENECA ST
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City | TUCSON
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State | AZ
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Zip | 85712-3272
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Country | US
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Telephone | 208-241-0558
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MACY JEPSEN
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Credential | SA-C
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Telephone | 208-241-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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